1. What his most recent estimate is of the shortfall in the number of midwives employed in (a) Kettering, (b) Northamptonshire and (c) England. (317471)

As of September 2008, there were 143 qualified midwives at the Kettering general hospital foundation trust and 161 qualified midwives at the Northampton general hospital NHS trust. It is, of course, the responsibility of trusts locally to ensure that appropriate midwifery services are provided. There are more than 25,600 midwives in the NHS. Trusts met the Government’s commitment to recruit an additional 1,000 midwives a year early and are on target to recruit 4,000 extra midwives by 2012.

There is a shortage of seven midwives at Kettering general hospital, which is actually very good compared with the shortage nationally. However, the real problem is the shortage of band 6 midwives—the more experienced midwives. As a result of the shortage, newly qualified trainees entering the system are not undergoing the preceptorship that they are meant to receive. What will the Minister do to address that problem?

The hon. Gentleman asks a very important question. At the same time as recruiting and retaining midwives, we are also looking at how we can retain experienced midwives by offering a more flexible approach to work and through working in teams. That is the way forward, and I am pleased to say that the vacancies at Kettering should be filled—I am led to believe that 12 candidates are now ready to be interviewed for the remaining six positions. We are also working closely with the Royal College of Midwives on the preceptorship.

Maternity services in Milton Keynes are currently being monitored by the Care Quality Commission following a second damning coroner’s report on a neonatal death in Milton Keynes. There seems to be a particular problem with recruiting midwives. Can the Minister point Milton Keynes to good practice elsewhere, to enable it to be more effective at recruiting the midwives for whom it does have funding?

My hon. Friend points out that the funding for the posts exists. In fact, nationally there has been a 38 per cent. increase in the number of student midwives, so we are hopeful that we will reach our target. However, I would ask her to work with the trust and the Royal College of Midwives, and I would be happy to meet her and explain in more detail our programme of events for retaining midwives.

The Minister has not really explained where the extra 4,000 midwives will come from. The Government’s own projections show that there will be an increase of only 1,000, but a 2009 memorandum on public expenditure states that between 2008 and 2012 an extra 1,500 will graduate each year. Yet the same memorandum projects about 1,800 new graduates a year. On my reckoning, that leaves us 3,000 short. Perhaps she can explain exactly where those 3,000 will come from.

I am glad to explain that to the hon. Lady. As mentioned in previous answers, we have been working most successfully with the Royal College of Midwives on a recruitment returners project. Actually, we are led to believe that a 38 per cent. increase in the number of students will deliver the target of an extra 4,000 midwives by 2012, and we are on schedule to achieve that. The extra money that has gone into midwifery has proved to be very successful, and of course we have made maternity services a priority, which is reflected in the latest NHS operating framework.

Is my hon. Friend aware that in Northampton there has been a particular increase in the number of babies born with special needs and that case conferences are needed because of child protection issues? Will she recognise that that is putting pressure on maternity services and will she support the primary care trust in looking into the reasons for that and in providing the support for the care needed for those babies with complex needs?

My hon. Friend asks about neonatal intensive care and the care of high-dependency babies. In the latter part of last year, we issued a new toolkit to enable PCTs to manage staff and situations better. Again, this is about retaining staff in a highly stressful area.

2. For what reasons the reciprocal health care agreement with the Isle of Man is to be ended; and if he will make a statement. (317472)

The Government decided to end their bilateral health care agreement with the Isle of Man on 31 March 2010, because it no longer represents value for money. Tourists will continue to receive free accident and emergency treatment but will now be expected to have insurance to cover the cost of further treatment.

I am obviously grateful to the Secretary of State for that factual response. However, clearly he will be aware that the Isle of Man is a Crown dependency, that the reciprocal health care agreement has been in place since 1948 and that the Government’s decision to end it at the end of next month was an arbitrary one without consultation. Has he given any thought to the impact on hospitals in the north-west of England, which could be affected by the decision, and to the position, in particular, of elderly people who go in their retirement to the Isle of Man and will be placed in financial difficulty when it comes to their health care?

I am aware that we are talking about a long-standing agreement, but I hope that the hon. Gentleman would accept that it relates to a different time, when lots of people from the north-west travelled to the Isle of Man for their holidays. The numbers travelling now are around half what they were in the ’40s, ’50s and ’60s of the last century, so there is no longer any basis for the agreement as it stood. I am sure that he would agree that, right now, I have to look at securing the maximum value for money from every piece of Government expenditure. However, I hear the concern that has been expressed by those in all parts of the House, so I will keep the matter under close review, as I said to the Chief Minister of the Isle of Man when I met him on 19 January.

Does my right hon. Friend agree that the success or otherwise of the reciprocal health care agreement with the Isle of Man has depended on the excellence of the hospital care available, particularly in Liverpool? Will he undertake to do everything in his power to advance the building projects at the Royal Liverpool University hospital and Alder Hey in particular, as there is some anxiety about whether we will see decisions on either in the near future?

I am certainly aware of the long historical ties between the Isle of Man and Merseyside, given my roots. I also congratulate my right hon. Friend on the ingenuity of her question, in mentioning the Royal Liverpool. There is a flow of patients from the Isle of Man to this country and vice versa, and we hope that that will continue. The Royal Liverpool is a crucial project of great significance for health care and the economy in Merseyside and the north-west. I would like to make progress on it shortly, but I am not in a position to make an announcement today.

3. What discussions he has had with the Minister for the Olympics on the preparedness of NHS London for the London 2012 Olympics; and if he will make a statement. (317473)

The Department of Health has been working jointly with NHS London, the London Organising Committee of the Olympic Games and Paralympic Games—LOCOG, as I understand it is known—and the Government Olympic Executive to ensure that the NHS will be fully prepared for the 2012 games.

How does the Minister reconcile those comments with those of Azara Mukhtar, the deputy director of NHS London, who said at a recent meeting that

“additional funding was not going to be forthcoming to support the commitment to offer free healthcare for those participating in the 2012 Olympics,”

and that there were therefore serious

“concerns about how to resolve the cost and resource implications without diverting funding from services for Londoners”?

Fairly easily. The Department of Health has provided NHS London with an extra £1.5 million for this financial year, which it has confirmed meets its current requirements. The Department is also in discussions with NHS London authorities on the provision of further funding, and we are going through some figures that they have provided us with. At the moment they look to be figures for a worst-case scenario, but we want to go through the detail and examine what is needed. However, we are certainly clear that the health needs of Londoners will not be compromised and that the health needs of visitors will be met.

But the figure of £1.5 million that the Minister just cited is well short of the £30 million that is the estimated cost to London of putting on the games. Will the Minister publish the information that NHS London has given him, as well as the understanding reached when the games were bid for, about how much they would cost Londoners through the NHS?

First, the figure that the hon. Gentleman gave is contrary to some of the figures that have been circulated recently, which have actually been larger. NHS London has put forward a figure of £41 million, as a cost spread over four years. That is based on planning assumptions that appear to be based on a worst-case scenario, and were made last summer. We know that there is a good deal more planning work to do, to ensure that we estimate the cost much more carefully and get the figures right, and that we must work with NHS London so that our health care needs are delivered.

4. What his most recent assessment is of the adequacy of provision of intermediate care in (a) north-east Hertfordshire and (b) England; and if he will make a statement. (317474)

In 2009, as part of the prevention package for older people, the Department issued revised intermediate care guidance, entitled “Halfway Home”, which strengthens the original 2001 guidance. It is for local NHS and social care commissioners to determine the range of services needed to avoid unnecessary hospital admission, help with timely discharge and prevent premature admission to long-term residential care.

I thank the Minister for his reply, but can it be right for the PCT review in north-east Hertfordshire, where we have relatively few intermediate care beds and where home services are relatively undeveloped, to be looking at possibly removing places from Royston hospital—that is, care bed places that are used currently—and if so, what is the future for all the people using those facilities?

I understand that a review of intermediate care is being carried out by the hon. Gentleman’s primary care trust and the county council. The Friends of Royston hospital and local councillors have been invited to a workshop in March, and the PCT will, subject to various approvals, begin formal engagement with stakeholders about the future of intermediate care in May or June this year. I hope that the hon. Gentleman will take every opportunity, as one of the local Members of Parliament, to make a contribution and give his support to the development of more intermediate care. He might be interested to know that the number of beds has doubled over the past 10 years, and that three times as many people are now benefiting from intermediate care. I hope that that is also true of his own area.

It sounds as though some of the changes to the hospital trust in north-east Hertfordshire are similar to those taking place at the Gloucester Royal hospital in my constituency, where four hospital wards are to be closed by 1 April, according to the chief executive of the hospital trust. This significant change is happening without any prior consultation with MPs or those in the local health community agencies. Will my hon. Friend urge the local hospital trust and its chief executive to consult before making such major changes?

Of course it is very important that local people—not least my hon. Friend, as the local Member of Parliament—have a chance to make their voices heard in regard to such changes. I urge all primary care trusts and local authorities to look at the guidance that we have issued on intermediate care. It talks about more flexibility in relation to the length of time people can get such care, as well as the need to ensure that people with dementia can have access to it, and the need to include reablement services, which are a critical part of the success of intermediate care. I hope that those messages will go out not only to my hon. Friend’s hospital but to every hospital across the country.

5. What recent representations he has received on the regulation of herbal medicine and acupuncture. (317475)

We received more than 6,000 responses to the consultation on the regulation of acupuncture, herbal medicine and traditional Chinese medicine. Ministers will receive a report on the analysis next month.

I am grateful to the hon. Lady; I understand that she has put in quite a lot of work on this. Given the rejection of the Booth case, which related to mis-prescribing, at the Old Bailey last week, is it not important to bring in this time frame? Secondly, is it not a fact that, in this time of economic difficulty, many Chinese practitioners are desperately seeking statutory regulation to give them a stamp of authority?

I understand very well the points that the hon. Gentleman makes. Indeed, the case to which he referred is deeply tragic. I accept that products can be damaging, which is why we are keen to take action. The importance of the consultation is obvious to me. It asks whether we should regulate and, if so, how. I am sure that he will join me in paying tribute to Professor Mike Pitillo—who, sadly, died recently—for the major contribution that he has made to this important area of work.

I congratulate the officials in the Department on their work on this matter, but does not the Susan Wu case add a sense of urgency to the need for us to grasp the nettle in regard to regulation in a sector in which the practitioners themselves are pushing for a regulatory framework to set standards within which they can operate securely?

I understand the sense of urgency that my hon. Friend conveys, but regulation needs to be balanced and proportionate, which is why the consultation is so important. We have to look at public safety, choice and access, but we also need to consider whether regulation is justified, and, if so, what type. We will make a decision as quickly as possible, as soon as the analysis has been received.

6. What progress is being made on preparation of the national autism strategy. (317476)

We have held a wide-ranging consultation to develop the national strategy for adults with autism, which has included contributions from an external reference group, adults with autism, service users, family members, staff and many third sector organisations. We have received more than 1,000 responses, and the work is progressing well. I am pleased to say that the strategy will be published in the first week of March 2010—that is, in just a few weeks’ time.

I welcome my hon. Friend’s answer, and the fact that the strategy will be published shortly. Will it specifically encourage the development of local specialist teams such as the Sheffield Asperger’s syndrome service, which is doing excellent work in diagnosis and the provision of support? He will be aware that the National Audit Office has identified such local specialist teams as providing particular value for money.

My hon. Friend is right to emphasise the value of specialist teams such as the one that she described. The strategy for adults with autism will include services for those with Asperger’s. It will cover adults across the complete spectrum, as we discussed at the reception that you hosted recently, Mr. Speaker, at which many Members were present. I cannot pre-empt what the strategy will say when we publish it, but we have heard many strong arguments for specialist teams, particularly in relation to diagnosis. There is not just one model—my hon. Friend the Member for Sheffield, Heeley (Meg Munn) cited one in Sheffield, but there are others around the country. I would certainly like to encourage those developments, while also enabling local flexibility so that variations can suit local circumstances.

Can the Minister confirm that the strategy will incorporate all the recommendations of the National Audit Office report on autism, as promised to the Public Accounts Committee by the Minister’s Department and the Department for Work and Pensions?

The hon. Lady, along with many other Members, played a crucial role in helping to develop the Autism Bill and the autism strategy, so I would like to place on record my thanks to her and other hon. Members. I know that the hon. Member for Chesham and Amersham (Mrs. Gillan) is not in her place, but she was also critical to that process.

We have had a number of discussions about the content of the strategy. The hon. Lady will have to wait until it comes out before I can say what it is, but we have certainly been mindful and supportive of many of the NAO recommendations. The NAO was helpful in highlighting areas to be included in the strategy. If the hon. Lady can wait just a few more days, she will see that we have developed a thoroughgoing response to its concerns.

A number of representations have been made to me by the support group in Halton and by parents of autistic children about whether the tribunals that hear the appeals on special needs and the education provision for their children are knowledgeable enough about the needs of children with autism. Within the strategy, will it look to ensure that the people who sit on those tribunals have the knowledge and background to be able to take fair and equitable decisions?

I just want to emphasise that the strategy is one for adults with autism, although I appreciate that my hon. Friend’s question was about the needs of children, statements made to the tribunals and so forth. However, the strategy will address issues connected with transition, when young people move from childhood into adulthood. My hon. Friend raises a key general issue—the training and awareness of professionals whether it is those sitting on tribunals, GPs or others in the system. We are very aware of that, so a key part of the strategy for adults with autism will be to raise general awareness, so that their needs are not overlooked in the years to come.

The consultation document set out five main themes, but I understand that the draft strategy deals only with two of them and repeatedly refers to existing workstreams that could be broadened—an approach that has failed before. The external reference group, which was disbanded in January, responded collectively, raising concerns about that approach, so why did the Government refuse to engage with that important group of stakeholders at such a key stage in the process?

Chair, we—[Hon. Members: “Chair?”] I apologise profusely, Mr. Speaker, forgive me.

The autism strategy, Mr. Speaker, has been developed in what I see as a co-production; we have worked jointly with a range of organisations, including the external reference group. I recently met the chair of that group to go through key features of the strategy. The external reference group saw the early draft of the strategy, but it has changed quite significantly since then, taking on board many of its concerns. Frustratingly, I repeat that I cannot say any more about it at this stage, as we will publish the strategy in a few days’ time. I am absolutely convinced, however, that the external reference group and Members across the Chamber will be pleased at the progress we are making in what amounts to a landmark strategy for this country.

7. How many NHS hospital trusts in the east of England have reported an anticipated deficit at the end of financial year 2009-10. (317477)

According to the East of England Strategic Health Authority, no NHS hospital trusts in the region are currently forecasting a year-end deficit for 2009-10. The overall forecast surplus for the East of England SHA remains at £167 million, but one primary care trust—the Peterborough PCT—is forecasting a year-end deficit.

It is about this time of year in previous years that PCTs in financial difficulties have tended to go to their local hospitals to say that they have been overpaid or that there has been over-performance; they demand money back, thus precipitating a sudden unexpected deficit or financial crisis. Can the Minister assure me that no PCT or hospital trust in the east of England is involved in that sort of negotiation and that by the end of the year there will be no such sudden unexpected financial problems?

I understand that East of England SHA supports Bedford Hospital NHS Trust and Bedfordshire PCT by providing mediation on a number of issues affecting the contract between the two parties. The most significant mediation in respect of payment for out-patient services concerned a payment of £2.5 million to the trust. Such issues do arise, but they are usually resolved by mediation.

That is a great improvement. When the Health Committee produced a report on NHS deficits in 2006, the east of England was one of the four areas in the greatest difficulty, but the money that the Government have put into the national health service has made it possible to smooth out the problems in the area.

As Chairman of the Select Committee on Health, my right hon. Friend knows a great deal about this subject. There has indeed been an impressive turnaround in financial performance in recent years, culminating in the achievement of a £40 million total surplus by acute NHS trusts in the east of England in 2008-09. The fact that the present Government have invested extra money, rather than cutting money like the last Conservative Government, shows that we are delivering where they failed to deliver.

Given increasing concern about the potential for deficits in hospital trusts and PCTs in the east of England and elsewhere, what reassurance can the Minister give about the Government’s commitment to implementation of the national programme of screening for abdominal aortic aneurysms, which have killed 30,000 men since 2002? I have been told by a vascular surgeon that the financial situation in Norfolk has effectively blocked the introduction of a screening programme there, and that similar circumstances exist elsewhere. Delay will kill more men. What commitment will the Government give to ensuring that screening takes place for men over the age of 65?

That is a good question. We want to ensure that we deal with screening issues as effectively as possible. The chief medical officer has been considering some of the issues, and I shall have a word with him and report to the hon. Gentleman on his conclusions.

8. What recent assessment he has made of the adequacy of the provision of upper gastro-intestinal services in Devon; and if he will make a statement. (317478)

In line with the national improving outcomes guidance, upper gastro-intestinal cancer surgery was moved from Royal Devon and Exeter and Royal Cornwall hospitals and centralised at Plymouth’s Derriford hospital on 1 January 2010. All pre and post-operative care for patients will continue to be provided locally.

That is as may be, but a constituent of mine says that having volunteered for a trial of a procedure intended to prevent post-operative complications when he was at Royal Devon and Exeter hospital in October 2009, before the move, he has been told that as a result of the move the trial has been cancelled. Can the Minister clarify the position in regard to research and trials in upper gastro-intestinal surgery since the move?

Some consultants who are carrying out trials involving particular kinds of surgery are reviewing the procedures that they use, and are currently discussing with colleagues how the operations can best be carried out in future. The issues are being examined by the clinicians involved.

9. How much his Department spent on procurement of swine influenza vaccines in the last 12 months; and how many units of vaccine have been procured. (317479)

As of Friday, the total amount of swine flu vaccine delivered to the UK from Baxter and GSK is approximately 38 million doses. Because contractual negotiations with GlaxoSmithKline are in progress and because of commercial confidentiality clauses in the contract, it is not possible to give a final figure on spend at this stage, but I will update the House in due course.

There were a number of odd developments during the swine flu pandemic—not least the fact that very little effort was put into stopping people coming into the country with swine flu, and the fact that people who had it were prevented from leaving. Is the Secretary of State willing to place in the Library the advice received by the Department that justified their decisions on swine flu, in connection with the vaccine in particular but in connection with other issues as well?

I will publish all the advice in due course so that the hon. Gentleman can see why those decisions were made. However, I ask him to cast his mind back to last summer in Birmingham, when there was a considerable increase in the number of cases over a very short period. That was a difficult situation. He must also not forget that there have been 309 deaths from swine flu in England, and that there are still people suffering from it in hospital today.

I believe that we took the right action. We made preparations, and we got the country through safely. We minimised the amount of disease and suffering as best we could. We will now learn the lessons of the decisions that were made, but I believe that we made the right decisions at the right time.

Does my right hon. Friend agree with many in this House that “You’re damned if you do, and you’re damned if you don’t,” and that we must always err on the side of the safety-first approach of making sure we have sufficient vaccine, if we can possibly procure it, for our citizens to keep them safe?

I am grateful to my hon. Friend for his question. Many people are being very wise after the event, but last April the situation appeared to everybody to be very different; we had a new virus spreading on a worldwide basis, and we had little information about it—about how quickly it would spread and its severity. In such circumstances, the only prudent course of action is to plan with safety first in mind, of course, but I am sure that when we reflect on these events, we will realise that there are things we might look at again, and ways we might further improve our pandemic planning in advance of any possible future pandemic. However, I think that, overall, the right decisions were taken, and that the NHS coped very well with a difficult situation.

Can the Secretary of State explain why there was a break clause in the contract with Baxter Healthcare, but there was no equivalent break clause in the contract with GlaxoSmithKline?

As the hon. Gentleman knows, as part of our planning we had entered into advance purchase agreements so that the UK was able to get swift access to the vaccine in the event of a pandemic. This was a good part of our preparations, and it put us at the very front of the queue internationally for swine flu vaccine. At the time, I do not remember anybody saying that that was the wrong thing to do. There were different arrangements with Baxter and GSK, which then led to different contracts. I am sure the hon. Gentleman would not expect me to go into all the details of those contracts on the Floor of the House, but I can assure him that at all times we have sought to get maximum value for money for the public while also protecting the public. We are still in negotiations with GSK, and once they are concluded we will be able to come back to the hon. Gentleman and give him a full report.

I am grateful to the Secretary of State, and, indeed, he knows that we called in this House for the establishment of advance purchase contracts for the vaccine and supported the action in implementing that, but we did so on the basis that break clauses would be included in the contracts. The Secretary of State also knows that last summer the question whether there would be a population-wide vaccination programme should have determined whether we were going to procure all the 90 million doses or a smaller amount. With Baxter, we could put in a break clause; with GSK, we could not. That is a fundamental difference between those contracts. Can the Secretary of State explain why there was no such provision in the contract with GSK?

The hon. Gentleman is right to say there was a difference between the two contracts. However, the overriding objective that my predecessor had to achieve was to secure enough vaccines to cover the whole population, and that meant having two doses for the population because that was the advice at the time. The hon. Gentleman must now accept that securing that vaccine was the overriding priority and that a contract had to be put in place to secure vaccines on that scale. Of course there are further discussions to be had with GSK to ensure maximum value for the taxpayer, and the hon. Gentleman would expect me to be pursuing those discussions, and we are. However, the first priority was to get enough vaccine to cover the whole population, and, of course, any commercial company needs sufficient security if they are to sign a contract of that kind.

The Secretary of State has still not explained why what was okay with Baxter Healthcare for 30 million doses was not okay with GSK for 60 million doses. Ministers have today announced in a written ministerial statement that they are transferring £200 million from the Department of Health’s capital budget to its revenue budget to meet the costs of the commitment on pandemic flu, of which the procurement of this vaccine will be a major part. The Secretary of State says he has 38 million doses; we have used 5 million. What will be the total cost of the procurement of these vaccines, and what capital projects will be cut back now in the NHS to pay for that?

May I gently caution the hon. Gentleman about being wise after the event? In proceeding on this, we communicated with him at all times. We explained the actions we were taking, and we took those actions in good faith at all times. May I also remind him that although we have secured a surplus, the H1N1 strain is likely to replace seasonal flu as the main strain this year?

We will continue to have a need for this vaccine, so we will announce in due course the arrangements that we are putting in place to ensure that we have sufficient stock. He will know that the chief medical officer’s advice to the at-risk groups is that they continue to accept vaccination because, although the second wave has ended, there could be a third wave later in the year. For all those reasons, we will proceed with caution. However, when we have concluded the negotiations with GSK we will set out exactly what we have done, so that the House can see the decisions we took and why we took them.

10. How much money his Department recovered from other EU member states for treatment of their citizens in the UK in the latest period for which figures are available. (317480)

In 2008-09, the UK received slightly more than £33 million from other member states. Given the nature of the process, payments are frequently made several years in arrears, so that figure does not represent the cost of health care, nor claims made in any one year.

I thank the Minister for that answer, but it is extraordinary: we pay our European Union colleagues more than £630 million each year for treatment provided to British citizens abroad, yet—I think she said this—we claim back only about £30 million for treatment provided to EU citizens in this country. Why?

The question I answered did not relate to moneys claimed, and perhaps it would be helpful if I were to explain further. The figures are not directly comparable because, for example, about 171,000 pensioners who are UK citizens live in Spain, France and Ireland—it is right that we are responsible for their health care—whereas only 5,000 registered pensioners from member countries live in the UK. I can assure the hon. Gentleman that the average payment per UK citizen who lives abroad is about £3,225 whereas the amount we claim per citizen from other member states is about £3,369.

Is it not a fact that many more British citizens live in EU member states than Europeans live here, and that they tend to be older and not at work, whereas the younger European citizens are working here? Thus, it ill behoves the Conservative party, despite its loathing for Europe, to bring this up with a xenophobic tone such as we have heard from those on the Conservative Benches.

It is true that we have responsibility for about 220,000 UK citizens who choose to live in other EU member states. The House might be interested to learn that from May new EU regulations will come into force that will speed up the reimbursement and claims process. That will be of benefit to all member states.

I must press the Minister further on her response to my hon. Friend the Member for Wellingborough (Mr. Bone). Despite considerable immigration into the UK in the past decade or so and according to Government figures, the amount that the UK is claiming against EU member states is less than 10 per cent. of the net UK payment to member states. Is she confident that these figures are comprehensive and complete? Could she explain why the Government are failing to reclaim 20 per cent. of the taxpayer’s money owed by these countries?

There is no failure to claim. [Interruption.] Because I am not that well qualified as an accountancy adviser.

Accounts are resource based, and if we look at those accounts—they are being referred to—we find that they do include money or claims yet to be received. I hope that the House will also be interested to learn that we have recently negotiated a deal with the Irish Government to reduce the UK liability by some €87 million over three years, and we will be reviewing our agreement in order to provide further savings. I hope that the House will welcome that progress.

11. What recent assessment he has made of the capacity of local hospitals in (a) Havering and (b) England to meet the demand for maternity services. (317481)

It is the responsibility of the local NHS to improve access to safe services and to improve outcomes for mothers and babies. In 2008, the Healthcare Commission published “Towards better births: A review of maternity services in England”, which assessed the quality, capability and efficiency of maternity services in England.

Queen’s hospital in Havering caters for 7,000 births a year, with the overflow going to King George hospital in Goodmayes. NHS London is proposing to close the maternity service at King George and transfer another 3,000 births a year to Queen’s in Havering. Does the Minister share my concern that when Havering is over capacity, which it undoubtedly will be, new mothers will have to travel much further afield? Should the maternity service at King George not be retained and kept open?

I thank the hon. Lady for the way she asked her question. She will of course be aware that the birth rate in north-east London is higher than that in the rest of the country and is expected to continue to rise over the next few years. That will put increasing pressure on maternity and newborn care services. I know that the aspect of service at King George that was mentioned is being clinically considered at the moment. That is all that will happen—it is way before any consultation process will even commence. Barking will open this summer, and that will also make a difference. I am fully aware that the clinical needs and safety of mothers and babies at all times must be taken into account.

12. What steps his Department is taking to support people who require assistance with the cost of health care to enable them to continue living in their own home. (317482)

NHS continuing health care may be available to help people to continue to live in their own home if they are assessed as having a primary health care need. Going forward, providing more care in the patient’s home can improve convenience, quality and value for money—for instance in areas such as renal dialysis—and there are more savings to be made from closer integration of health and social care.

I thank the Secretary of State for his reply. Enabling people to continue living in their own homes when they need care is a crucial part of developing a national care service. Does the Secretary of State agree that to create a national care service will require a consensual and non-party political approach, which the Opposition seem unable to comprehend?

I said when we published the Green Paper last year that I was seeking broad consensus on this issue and that remains my objective. It is one of the biggest issues that we face as a society, and I think that the country is looking to politicians to work constructively towards a durable solution. Before we leap to criticise each other, we need to focus on the fact that there are people today in all our constituencies paying the cruellest taxes of all—the costs of care that mean that the more vulnerable people are, the more they pay. A national care service will create a national entitlement and end the local lottery in which councils set different rules. The principle of a national care service has been widely welcomed, and I call on all sides to help us to make it a reality.

The Secretary of State will be aware that North Yorkshire is going down the path of allowing people to remain in their own homes. What does he say to GPs who will say to the Department that in rural areas such as North Yorkshire it is very difficult for carers to visit and deliver care to as many homes as they might in urban areas? That is a great challenge that we face in delivering personal care in people’s own homes.

I certainly agree and the hon. Lady makes an important point. The different geography and demography of local communities mean that home care will be more suitable in some areas than in others. However, in an area such as North Yorkshire, I think that telecare will have an important part to play in ensuring that people can be monitored daily without their having to travel to a clinic or hospital. There is great potential in this field, although of course it must be a local decision. It must not be imposed on people but, where people want it, it can be convenient for the public and can provide value for money for the taxpayer.

13. What steps his Department is taking to provide information in a form accessible to blind, partially sighted and print-disabled people. (317483)

The Department of Health takes its responsibilities under the Disability Discrimination Act 1995 seriously, including helping people to access printed material. All Department of Health publications are published on our official website in the most accessible electronic format available with technology that can, for example, read aloud what is written. We also make publications available on request in Braille, audio, large print and other formats.

The DDA notwithstanding, it is still difficult for individuals to access their health information via accessible formats, and it is not always working on the ground. Does the Minister accept that health information can be very sensitive and that it is wrong that people who are sight impaired should have to depend on relatives, and sometimes strangers, to help them to access that information?

I totally agree. It is wrong for the NHS not to provide information in alternative or accessible formats for people who are blind or partially sighted. My hon. Friend will be pleased to know that the Department has issued guidance to every GP practice, primary care trust and strategic health authority to support service improvements. It will include guidance on improving the experiences of people with sight loss in receiving health care and advice.

Will the Minister consider the merits of transferring the money that is currently spent on translating documents into foreign languages to ensuring that more documents are translated into and are available in Braille? He will know that people can learn English, but that people who have no sight cannot just see instantaneously.

I understand the hon. Gentleman’s point. It is a challenge for all health care providers to ensure that such service users can access and use services by gaining access to written material. That is a matter for local decision making, but I hope that local providers will consider the needs of local populations and ensure that people from all communities can access the information that they need in a format that is suitable for them.

14. What the average waiting time was for operations for cancer in the latest period for which figures are available. (317484)

In the latest period for which statistics are available, 98 per cent. of patients started their first treatment within 31 days of being given a cancer diagnosis. Some of those patients will have benefited from the two-week wait, the 62-day standard and the new waiting time commitments in the cancer reform strategy.

I thank my hon. Friend for her response. Does she agree that it is now critical that the Government should proceed to implement the promised guarantee that patients will see a cancer specialist within two weeks? That is what the country expects and wants.

I thank my hon. Friend for making that point, because that is of course the case. We have used this year’s operating framework to ask all primary care trusts to examine GP practice and use of the two-week referral pathway. From 1 April this year, there will be a new right in the NHS constitution for patients to be seen by a cancer specialist within two weeks of urgent GP referral.

T1. If he will make a statement on his departmental responsibilities. (317496)

Today the Government are launching their consultation on a strategy for treating chronic obstructive pulmonary disease, which is the UK’s fifth largest killer. The strategy seeks to improve diagnosis and treatment of the condition, which affects more than 3.2 million people in England. Tomorrow we will publish the independent inquiry by Robert Francis QC into failures at the Mid Staffordshire NHS Foundation Trust. On Thursday, we will hold the first dignity action day.

I welcome the strategy on COPD, but let me return to cancer. The Secretary of State will be aware that the incidence of cancers is higher than average in parts of north-east London such as my constituency. That is the case for prostate and bowel cancers. What significant plans do the Government have to improve early detection, treatment and care for those who are most affected?

Waltham Forest was one of the early adopters of the Government’s bowel cancer screening programme, ahead of national implementation. We take these matters incredibly seriously, and, as my hon. Friend will know, we have extended the bowel cancer screening programme to men and women aged between 70 and 75.

When we came to government, we set ourselves the objective of reducing deaths from cancer among under-75s by 20 per cent. The latest report from the national cancer director says that we are well on the way to meeting that target, as the figures have come down by 19.3 per cent. We hope that we can make further progress, and my hon. Friend is absolutely right to say that this issue is a top priority for the Department and the Government. Going forward, we will have a one-week entitlement to tests for suspected cancers, because we believe that early diagnosis is absolutely fundamental to cutting premature deaths from cancer.

rose—

Order. May I remind the House that during topical questions, quick-fire questions and answers are required to enable me to maximise the number of people who can participate?

T2. Primary care trusts in the north-west currently have a year-to-date deficit of £15.3 million. Will the Secretary of State tell us, or give us a guarantee, that important services to patients will not be sacrificed in trying to reduce those deficits? (317497)

We have made it very clear that managers need to focus on ensuring that they deliver the best quality of care. The issue of finance comes second to quality. I can assure the hon. Gentleman that managers have been given that very clear guidance.

T5. Last year, a constituent of mine paid £4,000 for a private operation that she required to save her sight. A few months later, the operation was made available on the NHS by the National Institute for Health and Clinical Excellence. My constituent has obviously lost out. Will the Minister look again at the NICE appraisal system, and improve its transparency and speed of decision making, to avoid this situation in future? (317500)

I agree that transparency is important in all aspects of NICE’s work. Full details of its forward work programme are readily available on its website, wherever possible accompanied by expected publication dates for specific pieces of guidance. NICE consults publicly on each piece of draft guidance before making a recommendation.

Do Ministers agree that the work of the Health Protection Agency Centre for Emergency Preparedness and Response at Porton Down is absolutely crucial to the security of our country? In view of the work that that extraordinary organisation has done on swine flu and vaccinations, why on earth are they proposing to move it? Not only does it do research into the most dangerous pathogens that might afflict our country, but it puts practical science to work in making vaccinations against them. Why are Ministers proposing to move the establishment and its pathogens to Harlow in Essex?

I can assure the hon. Gentleman that no final decision has been taken, and I certainly share his views about the excellent work done by his constituents and others at Porton Down. I also understand that he had a very useful meeting to discuss the future there. I know he will understand that the HPA has to look at all options to further and develop the very important work being done for the future.

Since 2003, the median waiting time for in-patient treatment at York hospital has fallen from 15 weeks to five. Does the Minister agree that setting targets for waiting times has helped to bring them down and that abandoning the targets, as the Conservatives suggest, would cause waits to increase?

My hon. Friend will know that at the last election we set a challenge for the NHS to ensure that no patients waited longer than 18 weeks, other than those who opted out for clinical reasons or by choice. We have made amazing progress towards that goal. The NHS has risen to the challenge and 18 weeks is now the outside, with many patients being treated, as he says, on a much shorter timetable. In my view, removing the target would bring about the return of differential waiting standards across the country—what the public would describe as postcode prescribing or a postcode lottery. We will enshrine the right to treatment within 18 weeks in the NHS constitution as a patient guarantee.

T3. I am bearing in mind your stricture, Mr. Speaker. Will the Secretary of State rule out a death tax? A simple yes or no will do. (317498)

We published a Green Paper and are looking at all the options for building a lasting consensus on this issue, which is one of the most important facing the country. We would welcome Opposition Members rejoining the search for a national consensus, rather than making cheap points at Health questions today. It is a complicated issue that deserves a considered approach. I do not believe that making cheap remarks like that will help.

To ensure that GPs maintain their clinical skills, they undergo appraisal every year. Starting from next year, of course, that will lead to reaccreditation by the General Medical Council, but unfortunately the NHS appraisals toolkit has gone offline at the critical time in the year when GPs need to get their appraisals sorted out. Will the Minister make a statement to the House on where we are with that website, so GPs can be reassured that their skills will be tested in the right way and in due time?

It was found that the toolkit had the potential to be compromised. We therefore took the view that it needed to be examined properly and in effect repaired, to ensure that it cannot be accessed by hackers. Work is now ongoing: it is on schedule at the moment, but I will keep GPs and my hon. Friend informed about its progress.

T4. Following a seminar on Lyme disease that I hosted in the House in October 2008 and a question that I raised in the House in December 2008, the Under-Secretary of State offered to host a meeting about Lyme disease. I followed that up with three telephone calls to her office and one letter. Given the fact that there has been an increase of 90 per cent. in cases of Lyme disease since 2006, what kind of message are the Government trying to send to people suffering from the disease? (317499)

I remember the debate and the request. On my return to the Department, I shall enquire what is happening.

Am I the only one here to be concerned that primary care trusts are to lose their role as direct providers of health services?

We want to ensure that primary care trusts are the main way that patients ensure they get the services that they deserve. Sometimes it is better to ensure that those services are provided by organisations with which the PCT can act at arm’s length to supervise properly and ensure that they are acting on behalf of the patient and the taxpayer.

T6. The Secretary of State has often talked about phasing out car parking charges at hospitals like the Royal United Hospital Bath and the Great Western hospital, which serve my constituency. On the face of it, that is perfectly welcome. Will he tell us how that will be funded without cutting into front-line medical services, and how that will result in more parking spaces, which is what we need? (317501)

A consultation on our proposals to change car parking rules in the NHS closed last week. I hope the hon. Gentleman found time to contribute to that. The proposal is to phase out charges for in-patients. I believe it is unfair that people should not receive visits while they are in hospital from those who cannot afford the charges. The introduction of charges symbolised the NHS moving away from the patient and the public. If we can come up with a workable and fundable scheme, I believe it will be widely welcomed by patients and the wider public.

Are my constituents in Biddulph right to be concerned that, owing to design delays, their Biddulph health centre could become the victim of NHS capital funding cuts if the Conservatives were to win the general election?

I am afraid my hon. Friend will have to have discussions. I understand that the newly elected Conservative Staffordshire county council pulled the library out of the project at Biddulph and as a result there have been delays. If a Conservative Government were elected, I would be very fearful about the likelihood of any such project getting consent.

T7. What are Ministers doing to ensure that money which has been earmarked for PCTs for respite care for carers is getting to carers for respite care? (317502)

The hon. Gentleman and others have raised this issue. As part of the national carers strategy the Government have placed more than £150 million in primary care trusts’ budgets to ensure that those primary care trusts could complement the money that we have given to local councils—some £720 million over the past three years—to provide respite care. The combined funding to the PCTs and to local councils for respite care is some £975 million last year, this year and the next. It is a matter for local decision making to assess local needs, but I hope that the hon. Gentleman and others will ask their primary care trusts and their local authorities to do better in delivering the resources that the Government have allocated to provide respite care for carers, who do such an important job in the community.

Is the proportion of hospital trusts with anticipated deficits greater among those with significant private finance initiative funding than among those that wisely avoided significant PFI, such as the well managed and solvent New Cross hospital in Wolverhampton?

That is an interesting question. I will have to look up the detail. However, PFI has brought forward a series of projects and enabled us to undertake the redevelopment of more than 100 hospitals so that we now have a better health service with more modern hospitals than we have ever had in the history of the country. That is the result of the investment provided by the Labour Government.

T8. If national health service funding is meant to be allocated to trusts locally according to need, and if wards such as that which I visited in St. Thomas’ hospital at the weekend are clearly overstretched, why was Southwark primary care trust top-sliced? Six million pounds was taken back three years ago; it was told that another £8 million of its proper allocation would have to be taken back in the coming year; and it was threatened with more money being taken away from what it is told it needs. (317503)

Order. I am trying to help hon. and right hon. Members, but I need them to help me to help them—with short questions and short answers.

NHS London is well funded, and we want to ensure that it delivers for patients throughout London, including those at St. Thomas’ hospital.

The waiting list on south Tyneside for treatment by an orthodontist is more than three years, and 600 people are on the waiting list. The wait will be reduced to six months, because a new contract is being entered into, but achieving that will take three years. Will the Minister look into the situation and help?

I would be very happy to look at that and see what we can do to speed things up.

T9. Does the Minister agree that a good way to control binge drinking is to try to highlight and publicise the amount of kilocalories in a drink? Red wine contains 171 kilocalories, alcopops 187 kilocalories and a pint of lager 287—more than the doughnut that I have here, which I just got in the Tea Room. When will the Minister start to publicise those facts? (317504)

I thank the hon. Gentleman for bringing his snacks into the Chamber. The important point is what is on labels for alcoholic products, and we have just launched a consultation on that very matter. There has been huge success in making units better understood, and I regret the proposal from the hon. Gentleman’s party, which is to replace them with something unknown—that is, centilitres.

North Central London strategic health authority is planning massive cuts, a £500 million reduction in its budget and the closure of A and E departments, including one at the Whittington hospital. Many of us find those decisions unpalatable and wrong, but above all we have great difficulty bringing to account the people who are making those plans and decisions. Will the Secretary of State tell me how we can make those officials accountable to the public for their decisions and planning?

As I understand it, those reviews are at an early stage and there are no clear and firm proposals. Local clinicians need to be at the heart of those recommendations, and any changes need to, and must, be the subject of full local consultation.

Will the Minister ensure that when GPs in rural practices support community hospitals, no restrictions will be put on their rights to refer patients to those community hospitals?

GPs will need to work with their primary care trusts to ensure that hospitals referrals are made appropriately. GPs have a broad range of clinical freedoms in order to decide where they want to refer their patients.

A number of consultants at Wexham Park hospital have sent me a letter, which I have forwarded to the Secretary of State, expressing their belief and concern that the hospital’s accounts were rearranged to ensure that it achieved foundation trust status. Will the Secretary of State look into that question and ensure that the consultants’ concerns are responded to as quickly as possible?

My hon. Friend raises a serious issue, and I shall of course look into it closely and report back to her.

T10. Further to the question that my hon. Friend the Member for North Wiltshire (Mr. Gray) asked, is the Secretary of State aware of the great controversy about car parking at the Queen Elizabeth hospital in King’s Lynn, involving the displacement of cars on to quiet residential roads in neighbouring communities? Surely one way forward is for hospitals to charge on exit, rather than on a pay and display basis, so that people pay for the car parking that they use. (317505)

I know that this issue raises strong feelings throughout the NHS. Indeed, at many of our surgeries it is one of the issues on which we receive most representations. The NHS needs to pay a little more attention to the price and availability of car parking, and that is what I am encouraging it to do.

Given the success of the Government’s breast cancer screening programme in reducing mortality in London by some 30 per cent. in the past 10 years, and given that breast cancer remains the UK’s most common cancer, affecting one woman in nine, will the Minister ensure that there is a continued high rate of research in order to improve the survival rates and quality of life for cancer sufferers?

That investment in research will continue.

Why are the Government pressing ahead with the closure of small maternity facilities and increasing the size of those that are left when the evidence suggests that smaller units offer better services to expectant mothers?

At all times the safety of the mother and baby is taken into account. Any discussion in relation to closures or openings is always undertaken with the safety of the mother in mind, and that is done by clinicians.